Development of nursing research in Jordan (1986-2012).

AIM: To provide an overview of nursing research in Jordan based on the topic researched, source and setting of data collection, methodology, theoretical framework used and source of funding. BACKGROUND: Nursing research contributes to nursing education, clinical practice, health policy and the establishment of nursing research priorities in Jordan to guide future research. METHODS: Databases such as MEDLINE, CINAHL, Google Scholar, PubMed and national sources were searched for published articles related to nursing in Jordan through a range of keywords. Articles were included in the analysis if they were published in English or Arabic through December 2012. FINDINGS: The search resulted in the identification of 999 publications, from which 462 articles met the inclusion criteria and were included in the review. The highest percentage of studies (23% of articles) focused on nursing management issues. Forty-four per cent were conducted in a hospital setting; only six studies used a nursing theory. Seventy-seven per cent of the studies were quantitative and 29.0% were funded mostly by universities. Twenty-one per cent were not directly related to improving nursing education or practice in Jordan. A Jordanian Database for nursing research was developed as a result of this review. DISCUSSION: Jordanian nurses have slowly started to build nursing research, the real nursing research work in Jordan started with the return of the first PhD graduate to Jordan in 1986. CONCLUSION: Jordanian nurses in collaboration with international colleagues were motivated to publish research and build the body of nursing knowledge.

Syntheses and characterization of salts with the [Al(D)4F2]+ cation (D = pyridine or water).

Our approach for preparation of tetrakis-(pyridine)-difluoro-aluminum chloride was successfully deployed for the synthesis of corresponding Br and I compounds, respectively. By reacting AlX(3)·3Py (X = Cl, Br, I) with Me(3)SiF in pyridine, two of the three halogens X were substituted by fluorine atoms forming the "aluminum mixed halide" complexes AlF(2)X·4Py with the ionic solid-state structures [Al(Py)(4)F(2)]X. Whereas the (27)Al solid state NMR spectra of AlX(3)·3Py (X = Cl, Br) confirmed the existence of the expected singular σ(6)λ(3)-Al centers in their structures, the corresponding spectrum of AlI(3)·3Py does not contain any signal that belongs to a 6-fold coordinated Al atom. The elemental analysis data strongly support the 1:2-stoichiometry of the complex (AlI(3)·2Py), which in accord to the (27)Al MAS NMR spectra possessed only one σ(4)λ(3)-Al side as in the ionic structure [Al(Py)(2)I(2)]I. AlBr(3)·3Py was also transformed by pyridine into the ionic complex [Al(Py)(4)Br(2)]Br. The later was isolated from pyridine solutions, and its structure was determined by X-ray single crystal analysis. On the basis of our results, solvated [Al(Py)(n)X(2)](+) cations are most probably the dominating species in pyridine solutions of AlX(3). Thus, only two Al-X covalent bonds underwent X/F- exchange and the halogen exchange reactions were terminated at " [Al(Py)(4)F(2)](+) stage". The hydrolysis of [Al(Py)(4)F(2)]Cl by very diluted hydrochloric acid in methanol proceeded smoothly under preservation of the Al-F bonds and displacement of pyridine by water. The formation of the stable helical trans-octahedron [Al(H(2)O)(4)F(2)](+) cation was confirmed by single-crystal XRD analysis. By reacting [Al(Py)(4)F(2)]Cl with the cyclo-n-propyl-phosphonic acid anhydride [CH(3)CH(2)CH(2)-PO(2)](3), an unexpected F-migration from Al- to P- atoms was observed.

Reproductive and non-reproductive health status of women aged 15 years and above in southern Jordan.

Failure to address women's health, including their reproductive health needs, increases health care costs and social inequity. This descriptive study assessed the reproductive and non-reproductive health status of women over 15 years old in poverty pockets in the southern region of Jordan. Two villages were selected using purposive sampling and all women in the villages were invited to participate in a "healthy family week": 259 responded to the invitation. Although 49.4% of the surveyed women were overweight or obese, only 8.5% had high blood pressure. Reproductive health concerns included the high proportions of women married at an early age (15-20 years) (76.8%), having 5+ children (43.1%) and with haemoglobin level < 12 g/dL, indicating anaemia (55.5%). Urinary tract infection was the most common health problem (29.0%). Health care providers should be sensitized to the health needs of Jordanian women in general and those living in disadvantaged areas in particular.

Jordanian health care providers' perceptions of post-partum health care.

PURPOSE: This qualitative descriptive study explored Jordanian health care providers' perceptions of the health care that they provide for post-partum mothers. METHODS: Thirty Jordanian health care providers (physicians, nurses and midwives) participated in three focus group discussions. A content analysis approach was used to analyse the data as appropriate for descriptive qualitative inquiry. FINDINGS: Health care providers indicated that the care they deliver includes breastfeeding, family planning, childcare and laboratory tests. Health care providers reflected confidence in the care given but indicated the need for continuing education, more resources and expressions of appreciation. CONCLUSIONS: Findings provide insights into Jordanian health care providers' perspectives on post-partum health care and emphasized the importance of enhancing utilization of such care in Jordan. It is suggested that the Jordanian Ministry of Health develop a comprehensive plan of educational offerings for providers, with a standardized educational programme for post-partum women. It is essential that all health care facilities provide high-quality post-partum health care that meets the needs of the maternal/infant dyad. Like all qualitative descriptive studies, generalizability of the results may be limited to similar situations and cultures.

Simple antireflux valve in ileal bladder substitutes: an experimental study in dogs.

OBJECTIVES: To provide a simple, reliable, and easy antireflux valve in ileal bladder substitutes. METHODS: Forty centimeters of the terminal ileum were isolated. A double-folded pouch was formed using the distal 37 cm, of which the proximal 7 cm were left intact to act as a valve. The remaining distal 30 cm were detubularized. Suturing at the borders of the valve was performed through linear seromuscular grooves created by diathermy burn. The ureters were anastomosed end-to-side to the supravalvular segment. The pouch was anastomosed to the trigone after subtotal cystectomy. The technique was carried out in 10 female mongrel dogs. All dogs were evaluated by ascending cystography and excretory urography at 12 and 20 weeks. Autopsy and histopathologic examination of the valve were carried out after the animals were killed at 20 weeks. RESULTS: None of the 10 animals showed ureteral reflux in ascending cystography. Excretory urography revealed a perfect upper tract except in a dog that showed bilateral hydroureteronephrosis due to bilateral ureteroileal stenosis. CONCLUSIONS: This new valve is technically simple and easy. The procedure is not time consuming, and staples are not required. The vascular pedicle is not manipulated. A shorter ileal segment is used in this type of valve construction in comparison with that required for the intussuscepted valve. This valve appears to be reliable for reflux prevention in ileal bladder substitutes.

Effects of verapamil, prostaglandin F2 alpha, phenylephrine, and noradrenaline on upper urinary tract dynamics.

OBJECTIVES: The effects of verapamil (VRP), prostaglandin F2 alpha (PGF2 alpha), phenylephrine, and noradrenaline on upper urinary tract dynamics were studied in vivo, using a pig model involving 12 miniswine which were subjected to acute pharmacologic perfusion studies of the upper urinary tract. METHOD: Changes in renal pelvic pressure (Ppvs) and ureteral peristalsis frequency were recorded at 2 mL/min perfusion rate premedication, and then during perfusion with different concentrations of each drug tested in three experiments. RESULTS: Ppvs showed no significant variations with VRP perfusion when compared with premedication readings, whereas ureteral peristalsis frequency was decreased significantly by 10(-3) mol/L of VRP. PGF2 alpha perfusion caused no statistically significant changes in Ppvs when compared with premedication values, but increased ureteral peristalsis frequency from 3 to 6.5/min at a concentration of 2 x 10(-1) mg (200 micrograms). Phenylephrine HCl and noradrenaline perfusion increased Ppvs from 8 +/- 1.1 to 11.9 +/- 1.6 cm water at a concentration of 100 micrograms. They augmented the frequency of ureteral peristalsis from about 2.5 +/- 1.2 to 4.1 +/- 1.3/min. No systemic effects were recorded since pulse, respiration, and left ureteral activity were unchanged during pharmacologic perfusion of the right side. CONCLUSION: Pharmacologic manipulation of ureteral activity can be achieved via direct perfusion with no significant modulation of Ppvs or systemic impact. VRP-induced smooth muscle relaxation of the upper urinary tract may be useful in percutaneous surgery for stones.

Efficacy and safety of sildenafil citrate (Viagra) for the treatment of erectile dysfunction in men in Egypt and South Africa.

The efficacy of sildenafil citrate (Viagra), an oral agent for the treatment of erectile dysfunction (ED), has been demonstrated in global studies. This 12-week randomized, double-blind, placebo-controlled, parallel-group, flexible-dose study assessed the efficacy and safety of sildenafil to treat ED in men in Egypt and South Africa. Men with ED of varied etiology were randomized to receive sildenafil 50 mg (n=128) or placebo (n=126); doses could be adjusted to 100 or 25 mg. Questions from the International Index of Erectile Function (IIEF) assessing the ability to achieve (Q3) and maintain (Q4) erections demonstrated a significant improvement with sildenafil compared with placebo (P<0.0001). Improved erections were reported by 74% of patients receiving sildenafil and 27% of those receiving placebo (P<0.0001). Headache, dyspepsia, and flushing were the most common adverse events in sildenafil-treated patients. These results are consistent with clinical trials in other countries. We conclude that sildenafil is an efficacious and well-tolerated treatment for men with ED in Egypt and South Africa.

The value of the lysosomal protease cathepsin-d in egyptian bladder-cancer.

Cathepsin D was measured in cytosols of 60 malignant bladder specimens and normal tissue from the same bladder at safety margin 5 cm of the tumor. Significant elevation in cathepsin D level (50 +/- 3.5 pmol/mg protein) in bladder carcinoma compared to normal tissue (12.7 +/- 1.58 pmol/mg protein) was found. At 100% specificity, cathepsin D sensitivity was 78%. The positivity rate of cathepsin D increased in the presence of lymph node metastasis. The higher concentration of cathepsin D in malignant bladder tissue vs. normal tissue and its correlation with lymph node metastasis could reflect its importance as a marker of metastatic potentiality of primary bladder cancer.

Effect of internal ureteral stenting of normal ureter on the upper urinary tract: an experimental study.

The effects of internal stenting of a normal ureter on the upper urinary tract were studied in 34 male rabbits by plain films, intravenous urograms, and 99mTc-DTPA renography at weekly intervals. Moreover, pressure-flow studies of the upper urinary tract were performed, and urine specimens for culture were obtained preoperatively and at the time of sacrifice. Histopathologic examination of the kidney, ureter, and ureterovesical junction was performed after animal sacrifice. Hydroureteronephrosis and stasis with equivocal obstruction were noted after 1 week of stenting. These changes were reversible after stent removal. Prolonged stenting (> 3 weeks) produced moderate to severe hydroureteronephrosis, and renal function was lost in 2 of 18 renal units because of severe hydronephrosis or infection. Ureteral stenting did not produce obstruction at a flow rate as high as 8 ml/minute. Histopathologic examination showed dilation of the pelvicaliceal system and renal tubules, infiltration of the kidney and the ureter with inflammatory cells, mucosal ulceration, and muscular hypertrophy of the ureters. The bladder mucosa showed a severe inflammatory reaction, Brunn nests, and ulceration with occasional metaplasia. Stenting of normal ureters in rabbits produced no harmful effects on the kidney if the stents were removed within 1 week, but prolonged stenting could affect renal and ureteral integrity.

Management of ureteral strictures by different modalities and effect of stents on upper tract drainage.

Ureteral strictures were induced experimentally by unilateral partial ligation of the upper ureter on the left side in 56 female rabbits. Six weeks later, stricture stability was documented by intravenous urography. In all cases, there was fibrosis of the muscular wall of the ureter. The lumen, although narrowed to various degrees, was preserved in most animals, and moderate to marked hydronephrosis resulted. Control animals were not treated in order to study the natural progress of the stricture. The other strictures were treated either by dilation (catheter or balloon) with or without ureteral stenting, by intubated external ureterotomy, or by excision of the strictured segment and stented end-to-end anastomosis. Follow-up studies consisted of intravenous urography, renography, and histologic examination for 24 weeks. Ureteral dilation without and with 2 weeks of stenting could be an adequate treatment of strictures associated with a moderate degree of hydronephrosis. Intubated external ureterotomy did not give satisfactory results in any animal. Excision of the strictured segment with a stented anastomosis produced satisfactory results and has a great role in the treatment of the strictured ureter in comparison with the variable outcome of endourologic treatment. Stenting of the unobstructed ureter, tested in six rabbits, showed a positive correlation between renal obstruction and long-term ureteral stenting.

Bacteriuria following vaginal delivery.

Vaginal delivery may predispose to bacteriuria, as it entails repeated vaginal examination, compression of the bladder and sometimes urethral catheterization. One hundred and forty pregnant women were studied. Three samples of urine were used for cultures; the first at start of labor, the second 24 h after labor, and the third 14 days later. Culture plates were examined for total colony count, which was multiplied by 10 to give an estimate of the number of organisms/ml. Type of organism was identified. Nine of 112 women (8%) developed bacteriuria for the first time after labor. Of these, premature rupture of membranes occurred in four, prolonged labor in two, and cervical and vaginal tears in two others. Detection and treatment of postpartum bacteriuria could decrease the incidence of urinary tract infection.

Cultural meanings of childbirth: Muslim women living in Jordan.

This descriptive, ethnographic study focuses on the experience of childbirth for Muslim women living in Jordan. Thirty-two childbearing women were interviewed in the early postpartum weeks. The audiotaped interviews were transcribed and translated. Themes were identified from the rich, narrative data. Motivations for having children, as well as what constitutes the motherhood feeling, were described. Themes also included the importance of relying on God or Allah for support in childbearing and child rearing. A strong sense of the spiritual dimensions of giving birth within women's traditional, religious, and cultural context was identified. Findings from this study provide insight into the meanings of childbirth for Muslim women living in Jordan. These meanings assist nurses in providing culturally competent care.

Jordanian women's perceptions of post-partum health care.

PURPOSE: This qualitative descriptive study aimed to explore Jordanian childbearing women's perceptions of their needs for health care and the post-partum healthcare services they received. METHODS: Twenty-four Jordanian childbearing women participated in the focus groups. Discussions focused on infant and maternal health concerns, access to post-partum health care, including family-planning services, the characteristics and behaviour of healthcare providers, and suggestions for the provision of quality maternal post-partum health care. FINDINGS: The majority of the women indicated that most of the services perceived and provided during the post-natal period were related to child care. They indicated that they attend post-natal visits mostly for treatment, family planning and/or child care and stated that they have not been told about the post-natal visits during pregnancy, or after giving birth. CONCLUSIONS: Study findings provided insight and understanding of women's perspectives on post-partum health care and implied a need to translate qualitative findings into clinical practice guidelines. It is suggested that the Jordanian Ministry of Health develops a comprehensive plan to improve educational offerings for post-partum women, and ensure that all healthcare facilities offer affordable and high-quality post-partum health care.

Quantitative monitoring of extracellular matrix production in bone implants by 13C and 31P solid-state nuclear magnetic resonance spectroscopy.

We used (31)P and (13)C solid-state nuclear magnetic resonance (NMR) spectroscopy to detect and analyze the major organic and inorganic components (collagen type I and bioapatite) in natural rabbit bone and beta-tricalcium phosphate implants loaded with osteogenically differentiated mesenchymal stem cells. High-resolution solid-state NMR spectra were obtained using the magic-angle spinning (MAS) technique. The (31)P NMR spectra of bone specimens showed a single line characteristic of bone calcium phosphate. (13)C cross-polarization (CP) MAS NMR spectra of bone exhibited the characteristic signatures of collagen type I with good resolution for all major amino acids in collagen. Quantitative measurements of (13)C-(1)H dipolar couplings indicated that the collagen segments are very rigid, undergoing only small amplitude fluctuations with correlation times in the nanosecond range. In contrast, directly polarized (13)C MAS NMR spectra of rabbit bone were dominated by signals of highly mobile triglycerides. These quantitative investigations of natural bone may provide the basis for a quality control of various osteoinductive bone substitutes. We studied the formation of extracellular bone matrix in artificial mesenchymal stem cell-loaded beta-tricalcium phosphate matrices that were implanted into the femoral condyle of rabbits. The NMR spectra of these bone grafts were acquired 3 months after implantation. In the (31)P NMR spectra, beta-tricalcium phosphate and bone calcium phosphate could be distinguished quantitatively, allowing recording of the formation of the natural bone matrix. Further, (13)C CPMAS allowed detection of collagen type I that had been produced in the implants. Comparison with the spectroscopic data from natural bone allowed assessment of the quality of the bone substitute material.

Efficacy of tadalafil in Egyptian and Turkish men with erectile dysfunction.

A randomised, double-blind, parallel, placebo-controlled, 12-week study was carried out to evaluate the efficacy and safety of 20-mg tadalafil taken 'as needed' in a population of men with erectile dysfunction (ED) from Egypt and Turkey. One hundred and thirty-two patients were randomised in this study. Tadalafil was superior to placebo on all three co-primary efficacy end points. The mean change from baseline for the erectile function domain of the International Index of Erectile Function was 9.3 +/- 0.8 for the tadalafil group and 2.3 +/- 1.6 for the placebo group. Tadalafil-treated patients reported a significantly greater improvement in the mean percentage of successful penetrations (tadalafil: 34.5 +/- 4.1; placebo: -4.6 +/- 8.1) and successful intercourse attempts (tadalafil: 52.2 +/- 3.8; placebo: 16.8 +/- 7.8) than placebo-treated patients as measured by the Sexual Encounter Profile. Tadalafil was generally well tolerated with 82% of adverse events being mild in severity. Tadalafil 20-mg taken 'as needed' significantly improved the erectile function in Egyptian and Turkish men with ED.

Jordanian baccalaureate nursing students' perception of their learning styles.

AIM: The purpose of this descriptive study was to determine Jordanian nursing students' perception of their learning styles. METHOD: All nursing students enrolled in four universities offering a baccalaureate degree in nursing at the time of the research project (n = 420) were approached. A structured self-administered questionnaire (Autonomous Learner Index) developed by the researchers was used for data collection. The questionnaire was pilot tested on a sample of nursing students who were not included in the study. The tool was reliable with an alpha coefficient of 0.89. FINDINGS: The majority of Jordanian nursing students perceived themselves as independent learners. The vast majority of students indicated that they have a desire to learn new things, are curious to learn, and can identify their goal independently. However, a low percentage of students indicated having good study skills, ability to concentrate while studying and using their study time efficiently. The two-tailed t-test indicated no significant differences at alpha 0.05 levels between students' learning preferences and the selected demographic variables. CONCLUSION: Based on the study findings, it is suggested that nurse educators should provide positive reinforcement of students' active involvement in the learning process, which will stimulate continued self-direction. Moreover, courses on study skills, writing skills, and literature searching skills should be introduced early in nursing curricula.

A wall-incorporated valve for preserving continence: an experimental evaluation of a new technique.

OBJECTIVE: To describe a new continent valve incorporated as part of the wall of a urinary reservoir constructed from bowel. MATERIALS AND METHODS: The technique was evaluated experimentally in 12 dogs; 40 cm of the distal ileum were isolated and the proximal 30 cm detubularized. The adjacent distal 7 cm of the intact ileum (valvular segment) was tailored around an 18 F catheter. The opened ileum plus the valve were doubly folded to form a pouch and the valvular segment incorporated as part of the pouch wall. The pouch was anastomosed to the trigone after subtotal cystectomy; the ureters were not manipulated. The pressure profile of the valve and ascending cystography were assessed 20 weeks after surgery and the inner layer of the valve examined histopathologically after the animals were killed. RESULTS: None of the 12 dogs showed leakage through the valve at maximum filling on ascending cystography. The urodynamic assessment verified the reliability of the valve in maintaining continence and there were no problems catheterizing the valve. The histopathological examination showed that the valve was covered by intestinal mucosa. The new continent valve is technically easy to construct: the procedure is not time-consuming. staples are unnecessary and the mesenteric vascular pedicle is not manipulated. A shorter ileal segment is used in constructing this valve than is required for the intussuscepted valve. The wall-incorporated valve seems to provide a reliable and easily catheterizable continent stoma.

The distribution and comparison of glutathione, glutathione reductase and glutathione S-transferase in various camel tissues.

Extracts prepared from liver, kidney, lung and brain of camel contain glutathione, glutathione S-transferase and glutathione reductase. Liver had the highest level of glutathione (218.7 mumol/g wet weight) whereas brain had the lowest level (66.4 mumol/g wet weight). The highest activity for glutathione reductase was found in the kidney (2.6 mumol/min/mg protein) while the lowest activity was found in the lung (0.9 mumol/min/mg protein). Glutathione S-transferase activity was the highest in liver (4.2 mumol/min/mg protein) and the lowest in brain (1 mumol/min/mg protein). Purified glutathione S-transferases from lung, kidney, brain and liver were similar in their molecular size, subunit composition as well as immuno-reactivity and showed some differences in their response to heat and inhibitors.